The current state of the osteopathic profession: An in-depth discussion with two veteran DOs

In honor of having celebrated National Doctors Day on March 30, and NOM Week coming up on April 17-23, I wanted to take some time to reflect on the state of our profession. I have shared my own thoughts in past columns throughout the year, so instead I wanted to get a read on how some other physicians see the present and future of osteopathic medicine. I sat down (virtually) with two leaders in the osteopathic profession who are at different points in their medical careers: Richard Thacker, DO, and Sarah Wolff, DO.

Dr. Thacker is a graduate of the Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine. After completing an internal medicine residency in Pennsylvania, he became additionally certified in hospice and palliative care. He has practiced full-spectrum osteopathic internal medicine as well as hospice care for more than 20 years and currently serves as the Associate Dean of Clinical Resources at the Alabama College of Osteopathic Medicine. He is a member of the AOA Board of Trustees and Treasurer for the Osteopathic Political Action Committee.

Dr. Wolff is a graduate of Western University of Health Sciences College of Osteopathic Medicine of the Pacific. She completed a family medicine residency in Washington state and has practiced osteopathic family medicine for six years. She is currently the Director of Clinical Curriculum at Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest in Lebanon, Oregon. She has served as the AOA BOT Resident Trustee, as well as a member of the AOA Bureau of Emerging Leaders.

This was a great hour-long conversation with two outstanding osteopathic physicians. What follows is part one of an edited transcript of the discussion.

The first question is the usual one, but I want to spin it a little bit. Why osteopathic medicine, but more specifically, what attracted you to the profession?

Dr. Thacker: I was born and raised in Michigan, a big osteopathic state. But I spent my teenage years and beyond in Florida, where my primary care physician was a DO. He was a general surgeon who practiced primary care. That was my first known exposure to the osteopathic medical profession.

I attended the University of Florida and wanted to go to medical school, but I was a married psychology student at the time. The osteopathic profession recognized that I was a nontraditional student and appreciated my maturity, interpersonal skills and desire to practice primary care. Though I was born in the Detroit metropolitan area, I spent many formative years in a rural area of north Florida, so Nova Southeastern accepted me very quickly. I was ecstatic and so appreciative.

I’ve tried to give back to the osteopathic profession ever since because the profession has given me so much and saw something in me that other schools did not.

Was there something in particular that drew you to osteopathic medicine or was it just that in that time, in that era, it provided an avenue toward practicing medicine?

Dr. Thacker: Yeah, I think it was my avenue. I’m a first-generation college graduate. I applied to both MD and DO schools, but Nova Southeastern recognized something in me and accepted me. That was it. I didn’t even keep looking. That’s when I knew, “This is home for me. This is a real fit for me,” and I was not disappointed. I was so enthusiastic that I became the freshman class president and then SOMA president the next year. It was just a natural progression for me to stay involved and I’ve tried to continue that through my professional career.

That’s great. Dr. Wolff, same question to you.

Dr. Wolff: I thought I wanted to be a dancer, and then I got too tall. Like all ballerinas, you hit 5’5” and you’re out. So I had to figure out something else to do. Though I was still young, I decided I wanted to become a doctor. I’m kind of headstrong about reaching my goals, so I set out to do everything I could to get accepted to medical school. I got involved, took all the pre-med classes that I could in undergrad and ended up teaching in some of the labs at the University of Oregon. During this time, I fell in love with teaching. I thought, “Oh goodness, I’ve dedicated my whole life to being a doctor, and here I am in the wrong field. I’m going to be a teacher.”

I had signed up for this wonderful trip to go do “doctor-y” things in Africa. I’d already paid for it, and beyond that, I wasn’t going to walk away from a trip to Africa. I traveled with a group to Tanzania, where we educated members of the Masai tribe on digging holes, washing hands and vaccination. If we encountered someone we thought could benefit from medical treatment, we would give them a red ticket so they could visit our clinic that was staffed with local doctors and other doctors from the U.S.

I remember talking to a mom through a translator, telling her we were going to prescribe her son a medication to treat his malaria. To my surprise, the mom refused. I’m sure I looked like a deer caught in headlights. She proceeded to tell me that she had met Western medicine before, yet her son was still sick on his deathbed, so it clearly must not work.

In that moment, I realized that no one had ever explained to her how malaria is transmitted, treated and prevented. I was doing patients and their families a great disservice by dispensing medication without taking the time to provide education. This was the turning point when I realized I wanted to pursue a career in medicine.

I got back to the States and wrote a beautiful essay with a lot of help from creative writers, describing my desire to combine teaching with medicine and use my hands to make a difference in people’s lives. I asked a friend’s father, who is an MD and a program director, to read the essay and give me his honest opinion. His response was, “You’re applying to the wrong schools. You clearly want to be a DO, so why are you applying to MD schools?”

I did not even know what a DO was at the time. After doing some research, I realized, “He’s right!” and then I started applying to DO schools. I always joke that an MD brought me to osteopathic medicine, but it’s really true. He could tell from reading my essay that I was looking to make a difference in medicine and being an osteopathic physician was that difference.

Do you think the attributes that attracted you to osteopathic medicine still exist in the profession today? Would they be a draw for current students?

Dr. Thacker: I do think that we’ve been seduced a bit by numbers and data. Those have value, but we’re so much more than our individual parts. We’re more than the MCAT score and the GPA. Certainly, MCAT scores can help predict a student’s ability to take standardized tests, but I worry that we’re placing too much emphasis on these factors and not enough on the value of a student’s life experiences.

The rigors of medical school are intense; in fact, it’s harder than ever to succeed. There’s more to learn and less time to learn it. We can’t lose sight that osteopathic principles and practice (OPP) is a major component, and so you have to make more room for immunology and pharmacology. But you don’t take that away from OPP or anatomy and musculoskeletal medicine. That’s not going to help us maintain the distinctiveness of osteopathic training and practice.

Also, our training of students has been solidly based on community training in hospitals. Do we want some exposure to tertiary care facilities and university-based programs? Sure, but community-based training works, and our profession is known for our expertise in that area. I want us to appreciate all aspects of training and all backgrounds, but I don’t want to get too far from what got us here.

All of our students don’t have to go into primary care, but the number grows a little bit smaller each year and most of the internists I know are either sub-specializing or becoming hospitalists. I’m an internist, but I practice traditional medicine. My type is becoming extinct, and students joke, “Oh, you’re a dinosaur. Nobody’s doing that anymore.” And it’s true, there are not many of us around. I’ve watched these trends develop, and I think that the gravity of everything else in the world is pulling us away from our nucleus.

Pursuing a career in medicine has got to be a calling. I think the world has changed a little bit. In the past, if you were a smart kid, you went to medical school. Now, there are tons of smart students, and that doesn’t mean they’re going to medical school. Will you make a lot more money somewhere else? Yeah, and you could sacrifice less, maybe not have the same demands. But if you have the calling, then I think this profession still offers fulfillment.

Dr. Wolff, same question to you. Do you think the profession still has the same draw that attracted you?

Dr. Wolff: Yes, but I think it’s important to realize that while we may have created that draw, we don’t own it anymore. Many of our colleagues, be it MD or PA or NP, are now adopting some of the qualities that initially made our profession unique, like providing empathetic care and looking beyond lab results.

I think the attraction is there, but we still have to work on owning it. Our profession is made up of such a unique mix of physicians with diverse backgrounds who offer patients a wealth of knowledge and experience. The rest of the world woke up one day and realized the osteopathic profession was doing things right, so now we have to push ourselves to refocus on the initial things that made us special.

Make sure you check back next month for part two of Dr. Loveless’s conversation with Dr. Wolff and Dr. Thacker.

Related reading:

Thoughts on defending the osteopathic medical profession

The DO Day experience: Why advocacy means so much as a physician